Conspiracy of Hope by Renée Pellerin

Author:Renée Pellerin
Language: eng
Format: epub
Publisher: Goose Lane Editions
Published: 2018-08-11T00:00:00+00:00

Nine SLINGS AND ARROWS

When Cornelia Baines told her eightieth birthday party guests she suffered “not from the slings and arrows of outrageous fortune, but from the slings and arrows of outraged radiologists,” she was fresh from a new round in the mammogram wars. The latest volley of slings and arrows from radiologists had begun in February 2014, when she, Anthony Miller, and others published a twenty-five-year follow-up of the Canadian National Breast Screening Study in the BMJ. It was front-page news, and, indeed, radiologists were outraged.

Miller and Baines had last reported on their data in 2000 and 2002, concluding again that mammography screening had no benefit for women in their forties and no benefit greater than a clinical breast examination for women in their fifties. But Miller still had a niggling question: what if mammography proved to have an effect on mortality if the women were studied for a greater length of time? Without longer follow-up, he wasn’t content to say there was no benefit. So although he had retired from the University of Toronto and had moved on first to the NCI in the United States and then to the International Agency for Research on Cancer in Lyon and the German Cancer Research Center in Heidelberg, he hung on to the idea of having another look at the Canadian study’s data. He eventually secured funding and enlisted the help of Steven Narod, a senior scientist at Women’s College Research Institute in Toronto, along with Baines and the other members of the original team.

The screening phase of the study began in 1980. Ninety thousand women between the ages of forty and fifty-nine were recruited in fifteen centres across the country. Among the fifty thousand women under age fifty, half were given mammograms plus clinical breast exams annually for four or five years. The half in the control group were not screened. Among the forty thousand women over fifty, half were allocated to both mammograms and clinical breast exams and half were assigned only to clinical exams. For their 2014 analysis, Miller and colleagues combined the two parts of the study so that the mammography group included all the women screened by both mammography and clinical exams and the control group, the non-mammography group, included all the women who either had no exam or had only clinical exams. Miller would later be criticized for rolling the two age groups into one, but in the BMJ paper, the authors explained that they did so because the results either way were similar.

They looked at breast cancer incidence and mortality recorded among all women in the study to the end of 2005. First, they counted only the breast cancers detected during the screening phase and found 666 invasive breast cancers in the mammography group and 524 among the controls. After twenty-five years, 180 of those women in the screened group and 171 in the control group had died. Then they counted all the breast cancers detected in the two groups, both during the screening phase and through the entire follow-up period.

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